Pathological Gambling A Critical Review (1999) / Chapter Skim
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2: Gambling Concepts and Nomenclature
2: Gambling Concepts and Nomenclature
Pages 15-62
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From page 15... ...
A discrete, acceptable, and useful definition of pathological gambling would be based on a nomenclature applicable in a wide diversity of contexts (American Psychiatric Association, 1994~. Nomenclature refers to a system of names used in an art or science and is critical in conceptualizing, discussing, and making judgments about pathological gambling and related behaviors.
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Historically, the word "gambling" referred to playing unfairly or cheating at play. A gambler was defined as a fraudulent gamester, sharper, or rook who habitually plays for money, especially extravagantly high stakes (Oxford English Dictionary, second edition, 1989~.
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In addition to the possibility that gamblers will lose their money, they also risk experiencing a variety of adverse biological, psychological, and social consequences from gambling (American Psychiatric Association, 1994~. Personal aspirations and the social setting, however, can affect the likelihood of an individual's engaging in risky behavior, since aspirations will influence the perceived benefits and constraints of the risky situation.
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Today pathological gambling is understood to be a disorder characterized by a continuous or periodic loss of control over gambling, a preoccupation with gambling and with obtaining money with which to gamble, irrational thinking, and a continuation of the behavior despite adverse consequences. The official medicalization of excessive gambling is marked by its inclusion in the DSM (American Psychiatric Association, 1980, 1987, 1994~.
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Moreover, the range of different gambling behaviors is believed to be dynamic: for example, social or recreational gamblers can become problem gamblers; problem gamblers can become pathological gamblers, return to a level of social or recreational gam i
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Therefore, they are reluctant to consider this possibility as part of treatment efforts. In practice, pathological gamblers attending Gamblers Anonymous or undergoing forms of treatment other than self-help usually consider themselves as "recovering" from, but not ever cured of, their gambling disorder.
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, but debate about problem gambling creates public confusion and uncertainty about gambling problems and their effects on society (Volberg, 1998~. For example, in considering excessive gambling behavior, clinicians and the majority of researchers in the United States and
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of pathological gambling that have evolved over the past 20 years (American Psychiatric Association, 1980, 1987, 1994~. However, debate is ongoing as to their validity, as well as about broader conceptualizations of excessive gambling ranging from problem to pathological (Rosenthal, 1989; Shaffer et al., 1997; Rosecrance, 1985~.
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From page 23... ...
. The term "pathological" is defined in the Oxford English Dictionary as "caused by or evidencing a mentally disturbed condition." In 1980, the American Psychiatric Association adopted the term "pathological gambling" as the official nomenclature in the DSM-III to describe excessive gambling as an impulse disorder (the DSM criteria are discussed in the next section)
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In much of the research literature, problem gambling is used as an overlay to include pathological gambling (Shaffer et al., 1997~. In fact, the concepts are inextricable, because on the continuum of gambling behaviors pathological gambling encompasses problem gambling (i.e., all pathological gamblers have been problem gamblers)
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From page 25... ...
Moreover, clinicians and the self-help treatment community believe that pathological gamblers cannot successfully return to a level of social or recreational gambling. Development of the DSM Criteria Largely through the efforts of Robert Custer, pathological gambling was first included in the DSM in 1980 (see DSM-III in Appendix B)
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From page 26... ...
Based on these findings and the preference of clinicians in the United States and abroad that it be included, "loss of control" was reinstated as a diagnostic criterion, but with the wording improved from DSMIII-R. The resulting definition of pathological gambling was published in 1994 in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)
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The wording and selection of items and the diagnostic cut-off point of five or more were based on clinical data; a partial exclusion criterion was then added: "The gambling behavior is not better accounted for by a Manic Episode." Although somewhat controversial, this exclusion was added because excessive gambling may result when a patient is experiencing acute mania, without the disorder itself being present (American Psychiatric Association, 1994~. The current description of pathological gambling in DSM-IV has been found to characterize pathological gambling in relatively precise operational terms; to provide the basis for measures that are reliable, replicable, and sensitive to regional and local variation; to distinguish gambling behavior from other impulse disorders; and to suggest the utility of applying specific types of clinical treatments (Shaffer et al., 1994~.
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Clinicians report that, although money is important, male pathological gamblers often say they are seeking action, an aroused euphoric state that may be similar to the high from cocaine or other stimulating drugs. Pathological gamblers report a "rush" characterized by sweaty palms, rapid heartbeat, and nausea or queasiness.
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Pathological gamblers experiencing cognitive distortions deny the reality of their gambling situation, including their odds of winning or losing (e.g., Langer, 1975; Langer and Roth, 1975; Ladouceur and Mayrand, 1984; Coulombe et al., 1992; Ladouceur et al., 1995~. They may fixate on particular numbers, days of the week, colors of clothing, or a particular slot machine or may possess other magical objects that for them signify or enhance luck (Toneatto, personal communication to the committee, June 2, 1998~.
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(1984) , the DSM-III created a new category of impulse control disorders, and this class of mental disorders was continued in the DSM-IV (American Psychiatric Association, 1980, 1994~.
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1995~. CLASSIFICATIONS AND CONTROVERSIES The American Psychiatric Association (1994)
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Comorbidity is the medical term used to describe the cooccurrence of two or more disorders in a single individual; comorbidity is extremely common among pathological gamblers (Crockford and el-Guebaly, 1998~. The problem of conceptually distinct multiple diagnoses can be taken to suggest that pathological gamblers suffer from a variety of interactive disorders.
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In a study comparing a group of pathological gamblers in treatment to controls from the community, Specker and colleagues (1996) found that a significantly higher proportion of pathological gamblers had at least one other impulse control disorder (35 versus 3 percent)
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require us to consider an alternative hypothesis: that involvement with gambling or other addictive behavior patterns can change the personality (Zinberg, 1975~. The experience of alcoholism or pathological gambling may shift personality attributes so that, when researchers examine subjects who already have experienced alcoholism or pathological gambling patterns, they seem to have personality traits that are different from nondrinkers or nonpathological gamblers.
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The inherent unreliability of averaging heart rate measures, since gambling activity for certain games like slot machines is intermittent, is also a problem with such studies. Coventry and Norman also attempted to account for some of these methodological problems in their study of offtrack horse bettors and found significant increases in heart rate compared to baseline nongambling conditions, as bettors placed their bets.
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And although the retrospective study by Rugle and Rosenthal (1993) suggests that, at least in a subgroup of pathological gamblers with high impuIsivity, the impuIsivity preceded the onset of gambling problems, longitudinal studies have not been conducted to establish that differences in impulse control characteristics predate the onset of gambling disorders, a necessary condition to establish a causal relationship.
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From page 37... ...
As such, many researchers have turned their attention to the extensive body of literature on addictions to explain pathological and problem gambling behavior. For example, research has begun to explore the possible biochemical basis of excessive gambling and its effects on the brains of pathological gamblers (Hickey et al., 1986; Koepp et al., 1998; Comings, 1998; Lukas, 1998~.
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Other Theories and Conceptualizations of Pathological Gambling The committee was charged to review excessive gambling as "pathological" as determined by the American Psychiatric Association. We were not charged with the task of determining the impact of excessive gambling caused by poor judgment untainted by illness.
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(For detailed discussion of biogenetic and medical explanations of pathological gambling, see Chapter 4~. Behavioral-Environmental Reasons Gambling may be viewed as a behavior that has been shaped in part by the environment, that is, pathological gamblers are people who have been susceptible to conditioning.
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For all of these reasons, excessive gambling may be viewed as a conditioned response to powerful reinforcers. General Theory of Addictions In response to the conceptual confusion affecting understanding of addictive and impulse disorders generally, Jacobs and others have emphasized the need for an overriding conceptual framework a credible and testable theory, supported by an empirically derived database that could clearly address the causes and the course of addictive behaviors Jacobs, 1987, 1988; Shaffer et al., 1989~.
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The chemical imbalance appears to supplant normal feelings of well-being with negative feelings. A recent study found that the genetic anomaly that interferes with the brain's reward process was present in more than 50 percent of a sample of white pathological gamblers (Comings et al., 1996~.
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As indicated in the table, many of the measures have not been evaluated and the others have received minimal psychometric evaluation. The exception is the South Oaks Gambling Screen (SOGS)
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In this view, the use of screening instruments to estimate a "true" prevalence of a disorder is one of several important methods in the process of acquiring prevalence estimates. Of course, all efforts to establish a prevalence estimate of pathological gambling rest on the assumption that a valid standard of the disorder exists.
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The Process of Determining Construct Validity Scientific research inevitably involves measuring things. The study of psychopathology involves measuring things that are not readily visible either to the naked eye or with contemporary technological instruments (such as microscopes or neuroimaging equipment)
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Individual and environmental factors that influence gambling onset and the development of an excessive gambling pattern would be identified. These factors could include player attributes (e.g., poor judgment and decision making, heightened motivation to seek stimulating sensations)
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Reliability refers to the capacity of an instrument to measure a relatively enduring trait with some level of consistency over time, across social settings, and between raters. If a given instrument consistently measures a phenomenon, it is said to be reliable.
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In addition, little is known about the dynamics of gamblers as they move from one level of gambling behavior to another. Clinical evidence suggests that pathological gamblers engage in destructive behaviors: they commit crime, they run up large debts, they damage relationships with family and friends, and some kill themselves.
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As a diagnostic guide, DSM-IV suggests that persons meeting 5 or more of the 10 criteria should be classified and treated as pathological gamblers. Even though the DSM-IV definition of pathological gambling is now widely accepted, there remains debate over the precise classification and construct validity of pathological gambling, and also over the conceptualization and definition of less severe problem gambling, which is not addressed in the DSM-IV.
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. Conversely, in 1973, "homosexuality" was removed from the second edition of the DSM (American Psychiatric Association, 1973)
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1994 DSM-IV: Diagnostic and Statistical Manual of Mental Disorders (4th ado. Washington, DC: American Psychiatric Association.
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Castellani, B., and L Rugle 1995 A comparison of pathological gamblers to alcoholics and cocaine abusers on impulsivity, sensation seeking, and craving.
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Fallik 1991 Personality dimensions of male pathological gamblers, alcoholics, and dually addicted gamblers. journal of Gambling Studies 7:133-142.
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Journal of Gambling Studies 6:165-182. Dohrenwend, B.P.
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journal of Gambling Behavior 4:27-37. 1988 A general theory of addictions: Rationale for and evidence supporting a new approach for understanding and treating addictive behaviors.
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Blume 1987 The South Oaks Gambling Screen (SOGS) : A new instrument for the identification of pathological gamblers.
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1994 Self-Reported Physiological and Dissociative Experiences Among Pathological Gamblers. Paper presented at the Conference on Gambling Behavior of the National Council on Problem Gambling, Seattle, July.
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Kruedelbach, and A Russo 1987 Personality profiles of hospitalized pathological gamblers: The California Personality Inventory.
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Rosenthal 1993 Impulsivity and pathological gambling. Paper presented at the Symposium on Pathological Gambling, 146th Annual Meeting of the American Psychiatric Association.
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Marcotte 1996 Psychopathology in pathological gamblers seeking treatment. Journal of Gambling Studies 12:67-81.
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Albany, NY: Gemini Research. 1994 The prevalence and demographics of pathological gamblers: Implications for public health.
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Journal of Gambling Studies 9~1~:63-84.
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